Clinical Skills - Technique

What short-term (1-28d) catheters should you use?

PTFE (polytetrafluorethylene), plastic catheters (PVC)

Why use a short-term catheter for males?

Drainage of urine during or post-operatively, monitoring output during acute illness, obtain uncontaminated specimen of urine, measure micturition residual urine, urological investigations (urodynamics / xray), relief of acute retention of urine (bladder flow obstruction), continuous bladder irrigation to prevent clot retention post bladder surgery, relieve pressure in bladder due to urinary retention secondary to prostatism

What long-term (up to 12w) catheter should you use?

100% silicone catheters, latex catheters coated with hydrogel or silver, silicone-elastomer

Why use long-term catheter for males?

Patient with neurological condition or injury who have difficulty in completely emptying bladder, patients with outlet obstruction who may be unfit for surgical repair, post surgical drainage when ‘stenting’ of the ureter is required, management of terminally ill patients when micturition may be difficult / painful / difficult / or when skin integrity may be compromised, intractable incontinence (only go catheter route if all other avenues have failed and skin integrity may be compromised)

What are the risks of male catheterisation?

Bacteriuria and UTI, bleeding, urethral stricture, loss of bladder tone

How do you prevent loss of bladder tone upon fitting?

Fit a flip-flo valve to the catheter in mobile patients

What are the contraindications to male catheterisation?

Urethral stricture, urethral tear

How is urethral tear suspected and how is it then ruled out?

Blood at meatus indicates trauma; patient needs imaging of UG tract; retrograde urethrogram needs to be performed to rule out tear

What equipment is needed for male catheterisation?

Catheterisation pack - sterile field / drape, gauze; sterile gloves + apron; catheter (12-14 Fr for male); lidocaine urethral gel; 0.9% saline; sterile water for balloon inflation (usually 10ml); 10ml syringe; urinary drainage bag and catheter holder; specimen container (if urine sample required)

What are the steps for male catheterisation?

Clean trolley; store equipment on lowest shelf; consent patient; hand hygiene and apron; open catheter pack; empty saline into small well; open other packs; ensure catheter in date; prepare water for catheter inflation; perform hand hygiene and apply sterile gloves; ask patient to retract foreskin; clean glans starting from meatus and spiralling downwards using gauze and saline; use a second gauze to clean underside of penis and scrotum; insert lidocaine gel; allow 5 minutes for anaesthetic (cover patient with drape and leave for 5 minutes); remove gloves and perform hand hygiene; return to patient with new sterile gloves; place fenestrated sterile drape over penis (avoid contact with penis); place receiver between patient legs; open catheter sheath 1cm; hold penis with non-dominant hand; slowly unsheathe as you insert catheter; at bladder urine will flow down catheter - advance another 6-8cm; remove remaining sheath; urine will flow out so catch in tray; connect collecting bag to catheter (larger port); inflate small port with water; withdraw catheter to ensure fixed; replace foreskin over glans or else paraphimosis may develop; clean patient; measure urine output and also monitor renal function and fluid balance

What is paraphimosis?

Foreskin has been retracted and cannot be pulled forward again; foreskin behind the glans can tighten and obstruct venous/lymphatic drainage of glans; swelling and oedema of glans results

Why may catheter not drain urine?

If equal fluid balance then normal - however encourage patient to drink or prescribe fluid; if positive fluid balance then do an abdominal assessment, bladder scan, palpate bladder

How do you troubleshoot a non-draining catheter?

Unblock debris build up around drainage hole - 50ml and aspirate back out; if unsuccessful, deflate balloon and reposition catheter; if unsuccessful, remove and seek senior advice

Why use a short-term catheter for females?

Drainage of urine during and post-operatively; monitoring output during acute illness; obtain uncontaminated specimen of urine; measure post micturition residual urine; urological investigation (urodynamics, xray); relief of acute retention (outflow obstruction); continuous bladder irrigation to prevent clot retention post bladder surgery; pre- and post-partum or during labour

Why use a long-term catheter for females?

Patient with neurological condition or injury who have difficulty in completely emptying bladder, patients with outlet obstruction who may be unfit for surgical repair, post surgical drainage when ‘stenting’ of the ureter is required, management of terminally ill patients when micturition may be difficult / painful / difficult / or when skin integrity may be compromised, intractable incontinence (only go catheter route if all other avenues have failed and skin integrity may be compromised)

What are the risks of female catheterisation?

Bacteriuria and UTI, haematuria (patients on aspirin or warfarin at increased risk)(recent trauma, surgery, cancer also increases risk), urethral structure, loss of bladder tone, sexual function, antibiotics (patient on antibiotics has high risk of further infection)

What are the contraindications of female catheterisation?

Urethral stricture, urethral trauma (investigate if blood at meatus)

What equipment is needed for female catheterisation?

Surface wipes, 10ml syringe, alcohol gel, procedure pack, urine collection device, sharps box, wipe for medical devices, gloves, blunt fill needle, water ampule, lidocaine gel, catheter

What are the steps of female catheterisation?

Clean trolley; equipment on lower shelf; consent; place patient supine with knees flexed and separated and feet flat in bed about 60cm apart; gloves and apron; open catheter pack; empty saline into well; open other packs and ensure catheter in date; prepare water for inflation of catheter balloon; hand hygiene and sterile gloves; hold labia open and with dominant hand clean urinary meatus using gauze soaked in saline (each piece for a single downward motion only); insert lidocaine gel (6ml); cover patient with drape and leave for 5 minutes; remove gloves and hand hygiene; return with new gloves; apply fenestrated sterile drape; place receiver between patient’s legs; open catheter 1cm; advance catheter about 5-6cm; when urine flows advance another 1-2cm; fully remove catheter sheath; connect collecting bag to larger port of catheter; inflate balloon with syringe; withdraw to ensure catheter is fixed; tear off fenestrated drape; dry patient; measure urine and also monitor renal function and fluid balance